 The next item of business is tough Lots Questions cezyn wa into question, number one. I call Tess Wyeth Tess Wyeth worrying The first I address not to the Scottish Government, whether it will provide an update on the cyber attack on 4 August 2022, which reportedly targeted NHS Scotland's patient management software. Sis vonasydayas 40 be petals users that one advanced a service provider for health and social care across the UK had experienced a cyber attack. The UK-wide incident was contained by the supplier within a few days, supported by the National Cyber Security Centre. Regular public updates on the cyber incident and subsequent recovery were reported by the supplier. One advanced, covering all systems impact to the Scottish Government, commented publicly at the time. The target for the cyber attack was one advanced and not NHS Scotland health boards. The ADASTRA system used by out-of-hours GPs in Scotland, which was the main system impacted up here, was brought back online in October. Let me make it clear, Presiding Officer. No NHS Scotland patient data was affected and well-established contingency arrangements were in place to sustain effective delivery. All one advanced systems have been tested and security checked with close working by NSS, with the National Cyber Security Centre and the ICO. I want to express my sincere thanks to everyone who has been involved in responding to this incident so swiftly. Following the attack, NHS staff were forced to keep patient records on paper and in emails and in Word documents. There are serious implications for patient safety, privacy and trust. Can the Cabinet Secretary confirm the scale of the data breach, including the number of patient records that were affected by the attack, and what measures were put in place to keep patient data safe as digital systems were restored? Let me confirm what I said in my response just a moment ago that no NHS Scotland patient data was affected. Importantly, this is an important point that Tess White has rightly raised, that there was contingency absolutely put in place. First of all, core systems were fully restored and on-going monitoring by Scottish Government resilience officials was very much in place. We were working on a four nations basis attack that affected every part of the UK. Local arrangements were also put in place to ensure resilience. The contingency arrangements used had been in place for many years. They are well understood by both NHS 24 and the service. Contingency arrangements included updates to NRWs GP records in line with standard processes. The attack took place. The contingencies that have been well rehearsed and well known about were put in place. I am pleased, as I said, that no NHS Scotland patient data has been affected. The alarming reality is that, with on-going geopolitical turbulence, we are seeing more and more malicious attacks like these. Healthcare is clearly in the perpetrators crosshairs. How confident is the Cabinet Secretary in the resilience of health boards to defend against future attacks? Does the cabinet secretary agree, with the former digital director of NHS National Services Scotland, that the NHS needs to up its game in the face of serious cyberattacks? Tess White, forgive me for what is an exceptionally important question. She is absolutely right to say that there are improvements to be made right across the board, particularly across the Scottish Government and the public sector, but we are committed to ensuring those improvements around cybersecurity for all the reasons that Tess White rightly raises in relation to state actors, as well as non-state actors. What I would give Tess White some reassurance around is that we work exceptionally closely with the National Cyber Security Centre. They advise right across the UK in relation to cybersecurity, and we have a contingency in place to deal with any attacks that take place. We work individually with health boards to do that. Again, I will be quite frank and honest with Tess White in my response that there are some boards who need that further support from the Scottish Government, and we are providing that support. Paul O'Kane It is shocking that this Parliament and, more importantly, the public may not have been aware of the scale and severity of the cyberattack had it not been uncovered in detail by a freedom of information request from Scottish Labour. It raises significant questions over transparency. Even by the standards set by SNP predecessors, the health secretary's report card is shocking. In 2017, following the last major cyberattack on NHS systems in Scotland, the then health secretary, Shona Robison, came to the chamber, made a statement and pledged to launch an inquiry so that lessons could be learned. Can the cabinet secretary explain why he failed to come to Parliament and make such a statement? Furthermore, can he explain what impact this cyberattack has had on waiting times and figures in NHS Greater Glasgow and Clyde? As far as I am aware, it has had no impact, but I am happy to look into that and come back to Paul O'Kane with further detail. What I would say to Paul O'Kane is that the cyberattack was reported in August by STV news, BBC news, The Guardian and the nine political programmes, which I think Paul O'Kane has been on on numerous occasions all in August. Of course, the Scottish Government commented publicly at the time. I will double-check my records, but I do not think, since that report and that very public extensive coverage of the cyberattack in August in the intervening four months, I do not think that I have had a single parliamentary question from Paul O'Kane, a single piece of written correspondence about the cyberattack on Paul O'Kane or a single request for an urgent statement from Paul O'Kane. If I am, if I have, and I stand to be corrected, I will, of course, correct the record. While I am concentrating on my job within the Scottish Government, I am afraid that I cannot do the opposition's work for them. To ask the Scottish Government what steps it is taking to tackle cancer inequalities. Can I thank Katie Clark for an important question? We continue to tackle cancer inequalities by ensuring equitable access to cancer services via our national cancer plan, as backed by £114.5 million. We know that the earlier cancer is diagnosed, the diagnosed easier is, of course, to treat and even cure, which is why we continue to invest heavily in our detect cancer early programme, which also focuses quite rightly in closing the very inequality gaps that Katie Clark asks about. In order to continue to minimise inequalities, we are currently developing a new 10-year cancer strategy and earlier diagnosis vision, which will launch in spring 2023. That will take a comprehensive approach to improving the patient pathway for all with a focus on reducing and eliminating those health inequalities that exist. I thank the cabinet secretary for that answer. Cancer Research UK reported this week that each year, around 4,900 extra cancer cases are linked to deprivation in Scotland. What proposals will the Scottish Government lay out in its upcoming cancer strategy that specifically addresses the challenge? I thank Katie Clark for her follow-up, too. Yesterday, I was speaking at the Scottish Cancer Conference, which is grateful for the CPG on cancer involved in the organisation of Miles Briggs for hosting that particular conference. I met the CRUK after that conference to talk through their report, and there are a number of interesting points made. Ultimately, the message from the CRUK was very clear to the Scottish Government. In the new cancer strategy, it expects a laser-like focus on reducing the inequalities that exist. I will not pre-empt that cancer plan. We have had many responses. I am very grateful to all those individuals and organisations that have responded to the consultation. I will launch that cancer strategy early in the new year. Katie Clark would like her conversation. In regards to that cancer strategy, my door is certainly open to that, but let me give an absolute assurance that reducing the cancer inequality gap that exists is certainly a high priority for us. I would be very grateful to take the cabinet secretary up on his offer. As he knows, academics and public health experts argue, it is impossible to tackle health inequalities without addressing wealth and income disparity. Public Health Scotland argue that a reasonable income for healthy living, sufficient welfare provision and what they call an active labour market policy are essential. Will the Scottish Government be willing to carry out research to analyse whether those policies are being enacted or attempting to be enacted, particularly in deprived communities? Cabinet secretary? I will certainly consider the proposal that Katie Clark has asked us to look into. There is no difference, I suspect, between her and I in relation to her premise, which is that inequalities, wealth inequalities undoubtedly lead to poorer health outcomes as well. That is why the work we are doing with the Government across the portfolio, for example, in the whole family well being fund, is so important. I would say to Katie Clark that she will know about a rapid cancer diagnostic services. We have just announced a further roll-out of another two. We can see that the interim evaluation from the first three RCTSs shows that there has been a significant impact into areas of deprivation. I can send her the further breakdown of that interim evaluation, but it goes to show that, through interventions, like the RCTS, we can target and focus into those areas of deprivation, and that will result in better outcomes for all. The Cancer Research UK's report echoes the evidence that we heard during our health committee inquiry into health inequalities, namely that socioeconomic inequalities drive poorer health, which we have just heard about. Does the cabinet secretary share my concerns that, in the midst of a cost-of-living crisis exacerbated by trust's disastrous mini-budget in September, that the chancellor's decision not to follow the lead of the SNP Scottish Government by matching progressive policies like the Scottish child payment and, instead, cut household incomes is going to have a direct impact on the health of many low-income households? Well, I think that there can be no doubt in that. I think that even those in the conservative benches would acknowledge that the UK Government's recent actions have exacerbated those wealth inequalities that exist. As I've said in my response to Katie Clark, that we can do what we can from a Scottish Government perspective, but, frankly, where the UK Government holds the vast majority of those fiscal levers if those wealth inequalities are not addressed, and that leads to poorer health inequalities for all. I've said quite clearly that, in my estimation, the cost crisis is also a public health crisis. We'll do what we can from a Scottish Government perspective to reduce that inequality gap that exists, but, in the meantime, I would appeal to all of those in the chamber, including those in the Conservative benches, to use whatever influence they might have to get the UK Government to change course and to ensure that they're not making the cost of living crisis even worse for those people that are already suffering in our communities across Scotland. Alex Cole-Hamilton Thank you very much, Presiding Officer. The health inequalities that Katie Clark rightly identifies across all cancer diagnoses and cancer types are manifest directly because of income inequality, but there is one kind of cancer where we have manifestly more to do and is in our power to do, and that is in terms of bowel cancer. I only learned today that we never really talk about bowel cancer in this chamber because we're meeting the target, the target for home care test kits being returned to the health sector, and that's because that target is only set at 60 per cent. Presiding Officer, this is a screening programme that we send to every adult of a certain age in our population, but we set the bar very low. Can I ask the health secretary whether his Government will consider increasing the target for home test kit returns so that we might actually catch more people, particularly in income-deprived backgrounds? I can thank Alex Cole-Hamilton for a very good question and a very reasonable point for me to consider, so I will take that consideration away. It is part of our consideration, I should say, in relation to screening. Whatever it is, our bowel screening programme has been incredibly successful and incredibly effective, but I take his point about being more ambitious about that screening programme, so I will take that away and I will get back to the member. Julian Mackay Thank you Presiding Officer. There are significant inequalities in access to screening. For breast and bowel screening, uptake is 20 per cent of points lower in the most deprived populations compared to the least deprived. For some, particularly those in rural areas, the cross of travelling to appointments will be unaffordable. Patients can apply to the NHS low-income scheme for assistance, but given the cost of living crisis, could the cabinet secretary review whether those payments are sufficient and are having the desired effect and what other solutions and support could be offered at a local level? I thank Gillian Mackay for the question. She is absolutely right. One of the key areas where we see inequalities is in and around screening. That is why I am keen that we use our mobile screening units that we have to ensure that they are getting into those areas of higher deprivation. On top of that, through the national cancer plan, we have allocated £2 million over £21, 22 and 23 to tackle inequalities in the cancer screening programme. That fund provided £5 million of funding over the previous five years to a number of projects. The specific aim was to tackle inequality and access to breast-build and cervical screening right across Scotland, but I will consider the issue that Gillian Mackay has put to me and see what more we might be able to do in this regard. To ask the Scottish Government what steps are being taken to tackle the illegal trade and puppies in light of the Scottish multi-agency strategic threat assessment report that the trade is funding serious organised crime. The Scottish Government continues to work with a number of key stakeholder organisations and other Government administrations through the puppy trade working group to disrupt the activities of those involved in the unlicensed puppy trade. We have also run several puppy campaigns over the past few years to highlight the cruelty of this trade, raise public awareness and provide advice on how to buy a puppy safely. New animal licensing regulations were introduced in 2021, which covered the breeding and selling of dogs, and further regulations are planned using powers set out in the Kept Animals Bill, currently progressing through the UK Parliament. Serious organised crime effects is all and we can all play a part in reducing the harm that causes. Raising awareness of the nature of the threats that we face is one part of that response, and the Scottish Government and its partners on the Serious organised crime task force oversee work being carried out to reduce harm caused by Serious organised crime in Scotland. We will continue to use every means at our disposal to disrupt Serious organised crime. I thank the cabinet secretary for that response. Illegally traded puppies generate around £30 million of revenue for serious organised criminal gangs in Scotland, fuelled no doubt by a huge rise in demand. Estimates are that one in four dogs that are purchased could be linked back to criminality and low welfare breeding. A number of very prolific Serious crime gangs are operating right now in Scotland both breeding within Scotland but also importing through the port of Stunrar. The Government's own Serious organised crime strategy barely mentions the trade of illicit puppy trading. There are doubts of that strategy. Surely it is robust enough given the scale of this activity. Can I ask the cabinet secretary for some statistics, though? Surely the law must be strong on that. How many crimes of this nature are reported to or investigated by the police each year? How many are then prosecuted by the crown? Of those, how many are successfully resulting in a criminal conviction? I say on the last point that Jamie Greene says that different elements of crimes can be recorded in different ways. I am happy to make sure that the answer that I give to him covers all the different ways on which it might touch on illicit puppy trade and provide that information to him in writing. I also challenge the point about how much has been done. The scale and significance of the trade was the driver behind the puppy trade working group back in early 2018. The UK and the Republic of Ireland multi-agency group includes key animal welfare organisations such as the Scottish Government, DEFRA, HMRC, Irish Revenue and COSLA. Of course, the UK has identified one of the ports of entry, and that is why we have worked collaboratively with the Irish Government as well. However, the principal aim is to disrupt the unlicensed, low-welfare puppy farming and associated criminal activity. It is taken very seriously. Jamie Greene, I know, is aware of the fact that much of what we say in relation to the SMASTA, as it is referred to as the Serious Crime Strategy, is not public for reasons that he is aware of. However, I am happy to make sure that as much information as possible is provided to him to convince him that we are doing what we need to do and that further action is proposed, not least in relation to the age at which puppies can be transported and the extent to which dogs in late gestation periods, which is often hard to determine, are also going to be addressed by perhaps reducing the time at which a mother can be transported when she is pregnant as well. We are taking serious action and I am happy to follow up on writing with the member. Jamie Greene, I would appreciate those statistics in writing where they are available. They say that a dog is for life, not just for Christmas, but the reality is that many of these dogs will live barely beyond Christmas, as many of them come with their own health issues, incurring huge vet bills and, sadly, dying young. It is also highly likely that right now there are online selling platforms advertising illegally traded puppies. I will not name and shame them because we do not hold parliamentary privilege in this place, but we know who they are and they know who they are, and it is shameful that they are not doing enough to tackle advertisements and sellers. I would like to plug the good work of the SSPCA and its Sayno to Puppy Dealers campaign, but what the Scottish Government is doing is to drive wider public awareness to inform the public of both the risks and the dangers, but also the moral issues of buying dogs from dodgy dealers, given that their last campaign was over four years ago. I have already mentioned that we carry publicity campaigns, but there are a number of other ways in which we can raise awareness. Jamie Greene's questions have perhaps been prompted by a press release issued by the Crown Office, which draws attention to those matters. Obviously, when the Smasta was published, it was highlighted at that stage. We do these things, and we do it partly by working with other organisations. The member quite rightly mentioned the SSPCA with him. We work very closely on that, but we will always look to make sure that we highlight it even more, not least at this time of year, when it can be the case that people want to buy a dog or a puppy for Christmas. To find some common ground, we are both agreed that this is an abhorrent trade and that we should do all that we can to limit it, not least because the very transportation of some of those animals is very detrimental to their health. We will continue to work on that, and as I say, I will provide the information that I mentioned earlier to the member. Further to that exchange, can I advise the cabinet secretary that my proposed bill, the welfare of dogs Scotland bill, is shortly to be presented to Parliament? Its purpose is for responsible dog ownership, in other words, tackling demand as a way of dealing with supply of the illegal trade. I associate myself with the exchange with Jamie Greene. As far as possible, stopping online purchase from places such as Gumtree. I ask the cabinet secretary—he has not got responsibility, his portfolio—that he will perhaps look forward, as I do, to Scottish Government support for my bill. I am not unaware of Christine Grahame's private member's bill. Just to say to her first point about trying to encourage responsible ownership, that has obviously got to cover people being conscious of where they have bought a puppy in the first place, just to go back to the previous discussion. We do welcome the proposals that seek to improve animal welfare, including Christine Grahame's welfare of dogs Scotland bill. I thank her for sharing a recent draft of that bill. Officials are still considering the proposals, and I look forward to discussing, or rather, the appropriate cabinet secretary. Mary Gougeon looks forward to discussing the bill in further detail when she said the chance to fully consider it. Animal welfare, as we are hearing, is an important and motive issue. I am sure that everyone in the chamber will welcome the opportunity to consider what more can be done to strengthen Scotland's high animal welfare standards. We have already heard that Cairn Rhyn and my constituency, unfortunately, has the reputation of being the main gateway from the Republic Island into the UK for puppy trafficking. Although the likes of Stenaline do a lot to detect the illegal trade, there are still puppies getting into the country. The dog trust has polled 2,000 puppy breeders, puppy buyers, and it showed that 30 per cent were still willing to buy a puppy, even if they thought that it had been illegally bred. Given that it is the run-up to Christmas and there is going to be a high demand for these puppies, sometimes going for as much as £3,000, what additional support can you give the SSPCA and the police in my constituency to make sure that that trafficking does not go on beyond the port, where we hear of stories of puppies being sold out in the back of vans on age 75 and age 77? Support that I have mentioned already, which is to work in collaboration with the SSPCA in relation to Police Scotland, they have overall an increase of £40 million in their budget for this current year, but of course the operational methods by which they drive down this trade is a matter for them. I should say that I would hope that the member would take some comfort from the serious organised crime task force, which is looking at this. It involves 13 organisations. That includes Solace, the national crime agency, COSLA, Police Scotland and others, and that refresh strategy was published in February this year. Although the aims and objectives remain broadly the same, to go back to the very first point that was made by Jamie Greene, which is about the fact that sometimes not just the appalling trade itself, but the procedure in that trade can feed further illicit activity in relation to drugs. There is a very serious focus on that, but it is not possible always to be as explicit about the way in which we are trying to deal with this area, because obviously we do not want to forearm those that are involved in this activity, but he should be reassured. There is a joint approach to this, and it takes in the Irish Government as well as the UK Government and the HMRC.